Infant and Young Child Feeding in Emergencies

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					   Infant and Young Child
Feeding in Emergencies (IFE)

    Origins of Ops Guidance
• Concept ‘do’s and don’ts’ emerged 2000
• IFE Interagency Group, Version 1.0, 2001
   – Version 2.0, May 2006
   – Version 2.1, February, 2007
• English, French, Spanish, Portuguese,
  Arabic, Russian, Chinese, Japanese,
  Kiswahili, Bahasa (Indonesia), Farsi
           Do’s and don’ts
• Need for clear, concise, practical guidance on
• Pull various components of a response
• Non-technical
• Not just nutrition and health staff, but
  including logistics, watsan, military,………
• 1-2 pager………………………26 booklet
          Operational Guidance
• Key audience: Emergency relief staff incl
  national governments, UN agencies, national
  and INGOs, donors

• International Code for Marketing of Breastmilk
  Substitutes embedded

• All emergencies in all countries and to non-
  emergency contexts (preparedness).

• Target group: infants and young children 0-2
  years of age and their caregivers.
Structure of the Ops Guidance
• Key Points
• Sections 1-6
  – 1. Endorse or develop policies
  – 2. Train staff
  – 3. Coordinate operations
  – 4. Assess and Monitor
  – 5. Protect, promote and support IFE
  – 6. Minimise the risks of Artificial Feeding
• Section 7 - Key Contacts
• Section 8 – References
• Section 9 - Definitions
       Section 9 Definitions
• Standard, internationally recognised
  – Infant, Exclusive breastfeeding
  – Infant Formula, Breastmilk substitute
  – Optimal infant and young child feeding
  – AFASS criteria – acceptable, feasible,
    affordable, sustainable, safe

• Standard definitions built upon
  – ‘Infant’ complementary food
  – Home modified milk
 Section 9 – Definitions, contd
• Created definitions
  – Nutrition and health emergency response:
    For an agency to be part of the nutrition
    and health response, they must have staff
    actively involved in the healthcare system
    who are responsible for targeting the BMS,
    monitoring the infants, and ensuring the
    supply of BMS is continued for as long as
    the infants concerned need it.
  1 Endorse or Develop Policies

1.1 Agency central level endorse/develop policy
  addresses protection and support of IFE
   – Makes specific reference to what should be
1.2 Disseminate it, integrate it, reflect it in
• Working examples – DFID, World Vision
• Country Level – National policy on IYCF in
  which IFE is specifically addressed
            2 Train Staff
2.1 Basic orientation for all national and
  international staff on IFE
2.2 Technical training for health and
  nutrition staff
2.3 Seek specific expertise national and
  international level on
  breastfeeding/infant feeding counselling
  and support
    3 Co-ordinate Operations
3.1 UNICEF co-ordinating agency (cluster
  approach) or designated agency with the
  necessary expertise
   – Policy coordination – specific policy for emergency
     operation based on national and agency policies
   – Intersectoral coordination – food aid, watsan,
     reproductive health
   – Action plan – identifies responsible agencies and
     mechanisms for accountability
   – Dissemination of policy and action plan , including
     operational agencies, donors, media
   – Evaluation of emergency response once an operation is
         4 Assess and Monitor
4.1 Key information on IYCF always be collected in
   initial rapid assessment (4.2 – details)
         -Conspicuous infant formula, infants not
   breastfed pre-crisis

4.3 Additional key qualitative and quantitative
        - Water availability and quality, fuel, potential
   support givers
        - Nutritional adequacy of food ration, infant
   feeding practices
4.3.3 Maintain records and share experiences
    5 Protect, promote and support IFE
  Integrated Multi-Sectoral Interventions

• Integrated multi-sectoral
  – Many direct and indirect supports of IFE,
    eg reproductive health, shelter, water and
    sanitation, food aid delivery
  – IFE not just a standalone intervention
     5.1 Basic interventions
• Meet nutritional needs of the general
  – Prioritise pregnant and lactating women with
    supplementary foods (5.1.1).
  – If foods are lacking, then multiple micronutrients
    should be given to pregnant and lactating women and
    children 6-59 months (NB Refer to guidance for
    malaria endemic areas) (5.1.2)
• Address infant complementary feeding from
  the outset
  – Supplement food ration with local foods, micronutrient
    fortified blended foods, e.g. CSB, WSB (5.1.3)
  – Commercial baby foods – consider cost and nutritional
    value and risk of undermining infant feeding practice
5.1 Basic interventions, contd
• Establish the population you are dealing with:
   – Demographic breakdown at registration of
     U2s (0-<6m, 6-<12m, 12-<24m)
• Registration of newborns within 2 weeks of
• Refugees and displaced populations
   – Rest areas, secluded areas for
   – Screen new arrivals to identify any IYCF
     problems and refer
  5.2 Technical Interventions
• Training of health/nutrition/community health
  staff knowledge and skills to support mothers
  and caregivers
• Integrate breastfeeding and IYCF into all
  levels of healthcare, e.g. maternity services,
  growth monitoring, selective feeding
• More targeted detailed support
   – Services to support orphans and
     unaccompanied children
   – Correct preparation of unfamiliar infant
     complementary foods
  5.2 Technical Interventions, contd

Address HIV/AIDS
  – Primary prevention, e.g. through condom
     provision (5.2.6)
  – Individual HIV status unknown, support
     optimal IYCF (5.2.7)
Testing and counselling in place:
  – Individual HIV negative, support optimal
     IYCF (5.2.7)
  – HIV positive women support informed
     decision about infant feeding choice
     applying AFASS criteria and supported to
     see this through (5.2.8)
  Infant feeding and HIV/AIDS in
5.2.8 Risk of infection or malnutrition from using
  BMS likely to be greater than risk of HIV
  transmission through breastfeeding.
   – EBF for first six months of life, with
     continued breastfeeding will give best
     chance of SURVIVAL
   – Decision based on individual
     circumstances but should take greater
     consideration of the health services
     available and the counselling and support
     she is likely to receive (WHO, 2006)
   – Mixed feeding is the worst option as gives
     highest transmission rate.
     6 Minimise the risks of any
          artificial feeding
6.1 BMS donations and supplies
• BMS donations are not needed
• Avoid soliciting or accepting donations of
• Any unavoided donations:
   – collected by designated agency
   – dealt with under guidance of
     UNICEF/coordinating agency and the
6.1.4 One agency supply BMS to another, only
  if both working as part of the nutrition and
  health emergency response and the
  provisions of the Code and the Ops Guidance
  are met. Both the donor and recipient agency
  are responsible to ensure provisions are met
  and continue to be met.
   6.2 Establish and implement
   criteria for targeting and use
6.2.1 Infant formula
  – Targeted to infants requiring it (criteria,
  – Assessed health/nutrition worker trained in
    BF and IF issues
  – Individual training on safe preparation
  – Follow-up at distribution site and at home
    (not less than twice a month)
6.2.4 UNICEF or designated nutrition
  coordinating agency responsibility to train and
  support agencies in training staff and mothers
  on safe preparation of infant formula in given
6.2.5 Assess whether AFASS prior to
  establishing a household based programme.
  Where safe preparation cannot be assured,,
  on-site preparation and consumption should
  be initiated. Ongoing assessment is critical to
  ensure conditions continue to be met.
  6.3 Control of procurement
6.3.1 Donor agencies considering funding:
• Ensure that the provisions of the Ops
  Guidance and the Code are met
• Cost implications to meet associated needs
• Interventions to support non-breastfed infants
  should always include a component to
  support breastfed infants
• Equal consideration should be given to skills
  based as to commodity based interventions
6.3.2 Type and source of BMS
• Generic (unbranded), locally purchased.
• Manufactured and packaged in accordance
  with Codex Alimentarius standards.
• At least six months shelf life on receipt of
• Type of infant formula appropriate for the
  infant, including age. Follow on milks,
  growing up milks, not necessary.
• UNICEF does not supply infant formula.
6.3.3 Labels – detailed requirements laid down
  by the Code
6.3.4 Infant formula supply is continued for as
  long as the infants need it:
   – Breastfeeding is re-established, or
   – At least six months of age and some
     source of milk/animal source food available
     (6-24 months of age).
6.3.5 Use of bottles and teats is discouraged.
  Use of cups promoted.
6.4 Control of Management and Distribution
6.4.1 Infant formula purchased by agencies
  working as part of the nutrition and health
  emergency response may be used or
  distributed by the healthcare system.
  Distribution should be discrete and not part of
  food aid distribution.
WHA 47.5: No donations of free or subsidised
  BMS in any part of the healthcare system.
6.4.2 BMS, milk products, bottles and teats
  should never be part of a general or blanket
Dried milk products should not be distributed as
  single commodity, only distributed if pre-
  mixed with milled staple food.
Single tins of infant formula should not be given
  to mothers unless part of an assured
  continuous supply.
No promotion at point of distribution – displays,
  leaflets with brands, etc.
           7 Key Contacts
7.1 Violations of the Code – report to WHO and
  International Code Documentation Centre
7.2 IYCF and/or coordination of IFE, contact
7.3 UNHCR milk policy, contact UNHCR
7.4 Feedback on Ops Guidance and share field
  experiences, contact IFE Core Group via
           In conclusion…..
•   Field driven policy guidance
•   Challenge is implementation
•   Responsive and timely updates
•   Feedback on use

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